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Benefits Calculator
Provider Services and Products
Patient Costs and Benefits
Routine Exam Cost
Refraction Cost
Exam Copay
Exam Copay
$ 0.00
$10.00
Hardware Copay
Hardware Copay
$ 0.00
$20.00
Contact Lens Fitting Copay
Contact Lens Fitting Copay
$ 0.00
Frame Out-of-pocket
Contact Lens Allowance
$ 0.00
$150.00
Lens Out-of-pocket
Contact Lens Fitting Cost
Contact Lens Cost
Contact Lens Out-of-pocket
Frame Allowance
$ 0.00
$150.00
Frame Cost
Covered Lenses
Select One
Single
Bifocal
Trifocal
Lenticular
Patient Responsibility
Polycarbonate (V2784)
$ 0.00
$35.00
Scratch Resistance (V2760)
$ 0.00
$15.00
Total Patient Savings
UV Treatment (V2755)
$ 0.00
$15.00
The "Benefit Calculator" is intended only as a guide to assist users in determining potential out-of-pocket costs for vision materials. The results obtained through the use of the "Benefits Calculator" are not guaranteed and are subject to the user's individual circumstances / benefits. If you have questions about the "Benefit Calculator", please call our Customer Relations Team at (800) 368-4790.
Formulary Progressive (V2781-PL)
$ 0.00
$85.00
Non Formulary Progressive (v2781)
$ 0.00
$85.00
Photochromatic (V2744)
$ 0.00
$40.00
Hi Index (V2782, V2783)
$ 0.00
$50.00
Tint (V2745)
$ 0.00
$15.00
Anti-Reflective Coating (V2750)
$ 0.00
$40.00
To reset calculator values to zero, click the RESTART button.
Misc. Add-On
Copay's and Dropdown lists.
Please note: The amounts listed in the dropdown boxes are specific to your benefit plan. Amounts listed in addition to zero are considered patient responsibility for the listed service/co-pay. If you do not see an additional payment amount in the drop down boxes, then there is no patient responsibility for that service/co-pay.
